Clinical characteristics, outcomes, and immunosuppressive strategies in sympathetic ophthalmia: real-world experience from a french tertiary center.

PURPOSE: Sympathetic ophthalmia is a rare, potentially blinding, bilateral granulomatous panuveitis that develops in the sympathizing eye following penetrating ocular trauma or intraocular surgery involving the inciting eye. Existing studies and case series focusing on IMT use in SO include patients in these studies were treated with cyclosporine or cyclophosphamide, drugs with considerable toxicity, and so do not reflect latest IMT approaches. We aimed to describe the clinical outcomes and therapeutical management of SO, in the setting of a tertiary Ophthalmology center in France.

METHODS

Retrospective observational single-center study: all patients with suspected SO seen between January 2008 and November 2024 at the Ophthalmology department in Pitié-Salpêtrière Hospital.

RESULTS

We identified 19 patients with suspected SO. Among them, 12 patients had confirmed SO. Mean follow-up duration was 12 ± 3 [1.5-23] years. sex ratio was 2:1 with 67% male patients. SO occurred within a mean 3.7 ± 4 years [0.25-27] years (median: 2.13 years), after the inciting event. Trauma and/or multiple intraocular surgeries in the inciting eye were present in all patients. Tocilizumab showed promising results in our cohort, with 2/3 patients achieving inflammation control for 4 and 8 years respectively, and no clinically significant side effects in all 3 patients. Anti-VEGF intravitreal injections (IVI) were added in case of associated choroidal neovascularization, intra-/periocular corticosteroids also played a key role in managing inflammatory macular edema.

CONCLUSION

Management of SO has significantly evolved over the past decades, with new immunomodulatory or immunosuppressive approaches providing an improved tolerance profile and better clinical outcomes. Further studies with a greater number of patients are needed to determine which treatment strategies would be most optimal.